Re: Insurance denying Remicade

[Guest guest]

I've never had my insurance company deny Remicade in particular, but I

have had them deny a drug before. My daughter has a pyloric spasm in

her stomach, and it was diagnosed when she was fairly young (4th

grade). The doctor put her on Prevacid, but the insurance company

didn't want to pay for that, and listed alternatives. Her doctor

wouldn't budge on changing meds, given her age, so they approved it.

I would suggest that you have your doctor's office contact your

insurance company if he is adament about you receiving Remicade

treatments, that they are the only treatment that will work for you,

and most insurance companies will give in. They usually say no at

first because it's a relatively expensive treatment, but if the doctor

refuses to switch, they should pay, but it might be at a reduced

amount.

Jen

[Guest guest]

>

> Has anyone who is/was receiving Remicade treatments recently been

> denied treatment by your insurance company?

When I had CIGNA they denied my Remicade. My Rheumatologist, however,

went to bat for me and wrote a letter. That was what it took for me to

get covered.

[Guest guest]

Insurance companies will try anything in the book to deny paying for the

anti-TNF drugs. They cost an arm and a leg. Most doctors know how to get around

this.....by giving another Dx for Spondy diseases. I forget what my doctor

listed....I think it was another type of arthritis. Most of the biologicals,

since I was on them, now except a Dx of Ankylosing Spondylitis and Psoriasis,

but you still might have trouble with ReA arthritis? They have conducted

separate double blind studies for these two conditions. They are probably doing

the double blind studies on other spondy diseases as we speak? Best regards,

Connie

[Guest guest]

My Enbrel was not denied, however they would only send me pre-filled

injectables and not the pens. Go figure. My Dr wants to add injectable

MTX instead of the pills so I didn't do anything about changing.

MK

[Guest guest]

Hello,

I don't have prescription coverage, so my Rheumatologist got me into the

Remicade Patient Assistance Program. I just started the second year on it.

Harv

[Guest guest]

There are several plans in the US for prescription assistance, one that I recall

most is Partnership for Prescription Assistance.

There are some hurdles for folks in Canada to some drugs but if your doctor

writes a letter to the Insurance Company, the company will usually let it

through. For instance, both Hazel and I have prescriptions for Neurontin, mine

for the generic pill Gabapentin and Hazel's for the brand name. She tried the

generic brand but was allergic to either the capsule material or one of the

fillers they use so Blue Cross and Great West Life agreed to pay for the brand

name. Even with double coverage we pay about 24 bucks per refill for Neurontin

and a refill of twice the number of Gabapentin costs me just over 3.00 and that

is in Canadian dollars.

There is one other hurdle to cross in Canada and that is a little know

bureaucratic committee in Ottawa called something like the Drug Review Board.

They have the power to override Provincial Health plans when it comes to

expensive drugs and lately they have been in the news for the ham fisted way

they operate.

Hopefully things will straighten out. Some of this I blame squarely on the Drug

Companies and the mechanism they have for determining the wholesale and retail

prices.

Hope everybody is enjoying the wacky weather. I can't believe it, Colorado gets

dumped on and up here it is brown again with warm temperatures. Actually the

temperatures are hovering a bit above and a bit below the freezing point and the

winds coming across the mountains from BC are driving me nutso with pain. We

live one block from the main Canadian Pacific Railway line through Canada and

when the wind has been blowing we cannot hear the train horns over the wind

noise. The folks on the West Coast in British Columbia had about 10 major

storms in roughly one month. They are slipping and sliding in the snow and ice

and the 8 inches of snow we received around Boxing Day is totally gone.

Blessings to all

Fr. Dave

[Guest guest]

Good for you!

jls648@... wrote: Hello,

I don't have prescription coverage, so my Rheumatologist got me into the

Remicade Patient Assistance Program. I just started the second year on it.

Harv